US Army Accession and Retention Standards: Impact on Obesity and Medical Readiness.

introductionMilitary body fat standards were implemented in the 1980s to prevent obesity and associated poor military readiness. In the past 2 decades, enforcement of existing Army body composition standards has been eroded by the steady increase in national obesity rates, the demand for new recruits especially during the 2007 surge in Iraq, and the COVID epidemic in 2020. The diminishing qualified recruit pool puts a new focus on accession standards. The purpose of accession standards is to ensure that recruits will meet soldier standards, but accession standards have been relaxed to improve recruitment with an assumption that most recruits will achieve the retention standards during initial entry training. A new method of percent body fat estimation (%BF) adopted by the Army in 2024 further liberalizes both accession and retention standards. This study examined the impact of current accession and retention %BF standards on the proportion of the US population that would be disqualified from Army service.

methodsThis analysis was based on National Health and Nutrition Examination Survey (NHANES) statistical sampling of the US population, where height, weight, abdominal circumferences, and dual-energy x-ray absorptiometry (DXA) %BF data were available (n = 26,090, including 13,302 men and 12,788 women). The proportion of individuals in the NHANES data failing to meet weight screen and %BF standards based on age and sex categories were calculated using DXA and the new Army anthropometric method. A recent large dataset from another service was used to compare the new method to DXA.

resultsNear one-third to one-half of American men and women failed to meet the current Army body composition standard (29, 39, 48, and 50% of men and 39, 45, 46, and 50% of women for age groups 17-20, 21-27, 28-29, and 40-59). More men than women benefited from more liberal accession standards to enter the Army above the retention standard to which they will be held after initial entry training (an additional 12, 11, 15, and 15% of men and 7, 1, 2, and 1% of women who met accession standards exceeded retention standards and would be expected to lose %BF after entry). Approximately one-fourth of women exceeded %BF but were under the height-weight screen; <10% of men were in this category. No men but 16% of the youngest women had low lean mass (<35 kg). DISCUSSION: Army body composition standards are generous, extending to the limits of increased metabolic health risks and providing underestimates of actual %BF based on the behavior of circumference-based methods of body fat estimation. However, current standards do not accurately select or track physical readiness, especially for women, and should be updated. Modernization of physical readiness standards to meet the needs of the Army of 2030 could include adoption of new technologies that directly assess central adiposity, adequate muscle mass, and replace fitness testing with cardiac output metrics. With half of US adults projected to be obese by 2030, it is time for a review of the strategic goals of modernized military readiness standards.